Shoulder arthroplasty in patients with glenohumeral osteoarthritis, glenoid bone loss and an intact rotator cuff: an algorithmic approach and review of the literature

Abstract

In patients with severe glenohumeral osteoarthritis (OA) and preserved rotator cuff function who have failed nonoperative treatment, anatomic total shoulder arthroplasty (TSA) has historically been the preferred surgical treatment. Shoulder arthroplasty in the setting of glenoid bone loss setting is technically demanding. Many techniques have been described to deal with glenoid bone loss including eccentric reaming, bone grafting, augmented glenoid baseplates, and patient-specific implants. Still, the decision to perform anatomic TSA or reverse total shoulder arthroplasty (RTSA) is often unclear, especially as the use of RTSA increases and evolves, making historical studies less useful when considering modern implant designs. RTSA has been advocated as a solution for patients with severe glenoid bone loss with intact rotator cuff function. Moreover, in appropriately selected patients, good outcomes can be achieved without the use of bone grafting or augmented baseplates. In cases of severe glenoid bone loss, RTSA can be performed with reaming the glenoid flat such that the baseplate rests on native glenoid bone. We have previously reported excellent prosthetic survival with this technique at 5-year follow-up. The purpose of this article is to highlight our suggested treatment algorithm for glenohumeral OA with glenoid bone loss and intact rotator cuff. Specifically, we focus on situations where RTSA may be preferred as opposed to anatomic TSA, and our suggested approach to managing bone loss intraoperatively in this complex patient population.

Trends in Shoulder Arthroplasty in Germany: A 10-Year Epidemiological Analysis of Patients with Primary Osteoarthritis of the Shoulder

“…However, there is a noticeable gap in research examining the specific details of primary osteoarthritis arthroplasty procedures over a longer period, particularly concerning the types of shoulder arthroplasties performed and their correlation with patient age. Although anatomic total shoulder arthroplasty (TSA) is conventionally preferred for patients with intact rotator cuff [16,17], reverse total shoulder arthroplasty (RTSA) has been demonstrated to be a viable option for patients with glenoid bone loss and intact rotator cuff function who may be elderly and less active [18]. Consequently, both anatomical and demographic factors appear to have a substantial impact on the choice of prosthesis.…”